TY - JOUR
T1 - Impact of the new rectal cancer definition on multimodality treatment and interhospital variability
T2 - Results from a nationwide cross-sectional study
AU - Hazen, Sanne Marije J.A.
AU - Sluckin, Tania C.
AU - Horsthuis, Karin
AU - The Dutch Snapshot Research Group
AU - Lambregts, Doenja M.J.
AU - Beets-Tan, Regina G.H.
AU - Hompes, Roel
AU - Buffart, Tineke E.
AU - Marijnen, Corrie A.M.
AU - Tanis, Pieter J.
AU - Kusters, Miranda
AU - Aalbers, Arend G.J.
AU - van Aalten, Susanna M.
AU - Amelung, Femke J.
AU - Antonisse, Imogeen E.
AU - Boerma, Evert Jan G.
AU - ten Cate, David W.G.
AU - Coebergh van den Braak, Robert J.
AU - Curutchet, Sam
AU - Dekker, Emmelie N.
AU - Demirkiran, Ahmet
AU - van Egdom, Laurentine S.E.
AU - El-Massoudi, Youssef
AU - van Elderen, Saskia
AU - van Gils, Renza
AU - van den Hoek, Sjoerd
AU - Hoff, Christiaan
AU - Imani, Farshad
AU - van Koeverden, Sebastiaan
AU - Kok, Sylvia
AU - Koster, Ingrid M.
AU - Kroese, Leonard F.
AU - Muller, Karin
AU - Musters, Gijsbert D.
AU - Noordman, Bo J.
AU - Olthof, Pim B.
AU - Oosterling, Steven J.
AU - van Rees, Jan M.
AU - Roosen, Lodewijk
AU - Rothbarth, Joost
AU - Spillenaar-Bilgen, Ernst J.
AU - Talsma, Aaldert K.
AU - van der Valk, Maxime J.M.
AU - Vanhooymissen, Inge J.S.
AU - Velema, Laura A.
AU - Verdaasdonk, Emiel G.G.
AU - Verhagen, Tim
AU - Vermaas, Maarten
AU - de Vries, Marianne
AU - van Westerveld, Paul P.
AU - Zheng, Kang J.
N1 - Publisher Copyright:
© 2024 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.
PY - 2024/6
Y1 - 2024/6
N2 - Aim: This study aimed to determine the consequences of the new definition of rectal cancer for decision-making in multidisciplinary team meetings (MDT). The new definition of rectal cancer, the lower border of the tumour is located below the sigmoid take-off (STO), was implemented in the Dutch guideline in 2019 after an international Delphi consensus meeting to reduce interhospital variations. Method: All patients with rectal cancer according to the local MDT, who underwent resection in 2016 in the Netherlands were eligible for this nationwide collaborative cross-sectional study. MRI-images were rereviewed, and the tumours were classified as above or on/below the STO. Results: This study registered 3107 of the eligible 3178 patients (98%), of which 2784 patients had an evaluable MRI. In 314 patients, the tumour was located above the STO (11%), with interhospital variation between 0% and 36%. Based on TN-stage, 175 reclassified patients with colon cancer (6%) would have received different treatment (e.g., omitting neoadjuvant radiotherapy, candidate for adjuvant chemotherapy). Tumour location above the STO was independently associated with lower risk of 4-year locoregional recurrence (HR 0.529; p = 0.030) and higher 4-year overall survival (HR 0.732; p = 0.037) compared to location under the STO. Conclusion: By using the STO, 11% of the prior MDT-based diagnosis of rectal cancer were redefined as sigmoid cancer, with potential implications for multimodality treatment and prognostic value. Given the substantial interhospital variation in proportion of redefined cancers, the use of the STO will contribute to standardisation and comparability of outcomes in both daily practice and trial settings.
AB - Aim: This study aimed to determine the consequences of the new definition of rectal cancer for decision-making in multidisciplinary team meetings (MDT). The new definition of rectal cancer, the lower border of the tumour is located below the sigmoid take-off (STO), was implemented in the Dutch guideline in 2019 after an international Delphi consensus meeting to reduce interhospital variations. Method: All patients with rectal cancer according to the local MDT, who underwent resection in 2016 in the Netherlands were eligible for this nationwide collaborative cross-sectional study. MRI-images were rereviewed, and the tumours were classified as above or on/below the STO. Results: This study registered 3107 of the eligible 3178 patients (98%), of which 2784 patients had an evaluable MRI. In 314 patients, the tumour was located above the STO (11%), with interhospital variation between 0% and 36%. Based on TN-stage, 175 reclassified patients with colon cancer (6%) would have received different treatment (e.g., omitting neoadjuvant radiotherapy, candidate for adjuvant chemotherapy). Tumour location above the STO was independently associated with lower risk of 4-year locoregional recurrence (HR 0.529; p = 0.030) and higher 4-year overall survival (HR 0.732; p = 0.037) compared to location under the STO. Conclusion: By using the STO, 11% of the prior MDT-based diagnosis of rectal cancer were redefined as sigmoid cancer, with potential implications for multimodality treatment and prognostic value. Given the substantial interhospital variation in proportion of redefined cancers, the use of the STO will contribute to standardisation and comparability of outcomes in both daily practice and trial settings.
UR - http://www.scopus.com/inward/record.url?scp=85191892497&partnerID=8YFLogxK
U2 - 10.1111/codi.17002
DO - 10.1111/codi.17002
M3 - Article
C2 - 38682286
AN - SCOPUS:85191892497
SN - 1462-8910
VL - 26
SP - 1131
EP - 1144
JO - Colorectal Disease
JF - Colorectal Disease
IS - 6
ER -
